Individual
JOHN CHARLES GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSSW
Contact information
Practice address
601 S 8TH ST, SHEBOYGAN, WI 53081-4405
(920) 458-5062
(920) 451-3941
Mailing address
N6128 WOODLAND RD, SHEBOYGAN, WI 53083-3219
(920) 467-4978
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
815-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39559100
—
WI
Enumeration date
09/07/2006
Last updated
07/08/2007
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